B/ 93 Inflammatory lesions of testis and epididymis, cryptorchidism, infertility

Question 1

Inflammatory lesions of the testis and epididymis

Answer 1

Epididymitis, Orchitis due to mumps, Granulomatous orchitis, Syphilis

Question 2

Epididymitis

Answer 2

Is the primary cause of epididymal obstruction. Usually it is related to cystitis, prostatitis, urethritis which will spread through the vas deferens or the lymphatics.
Can cause testicular ischemia and necrosis - later scarring and infertility. Can be caused by Brucellosis, Gonorrhea, Tuberculosis - the epididymis is enlarged, covered by fibrin and contain pus

Question 3

Orchitis due to mumps infection

Answer 3

Rare in infected children, but it occurs in 20% of adults infected with mumps. Occurs approx. 1 week after parotitis. Considerable loss of seminiferous tubules which leads to atrophy, fibrosis and sterility.

Question 4

Granulomatous orchitis

Answer 4

Uknown etiology. Sudden onset of tender testicular mass, variable fever. Benign although it can be associated with seminoma.
Appears solid, unilateral, nodular and enlarged - resembles lymphoma
Microscopically - lymphocytes and plasma cells infiltrate interstitium and surround the seminiferous tubules. Giant cells are present.

Question 5

Syphilis

Answer 5

STD caused by treponema pallidum. Has primary, secondary and tertiary phases.
Primary: painless hard chancre.
Secondary: Bacteremic stage. Widespread rash (small red macular lesions).
Tertiary: Gummatous form - granulomas with epithelioid and giant cell, obliterative endarteritis, and necrosis. There are also cardiovascular and neurological symptoms.
Diagnosis through Warthon-Starry stain
Other STDs - Neisseria Gonorrhea, Chlamydia trachomatis

Question 6

Cryptoorchidism

Answer 6

Testes do not travel down to the scrotum - can be complete or incomplete failure. Occurs due to hormonal abnormalities, intrinsic testicular abnormalities or obstruction of the inguinal canal.
Also associated with other congenital abnormalities such as Prader-Willi syndrome. The majority of the cases are idiopathic.
Leads to sterility, and an increased risk of testicular cancer. Orchiopexy (when you surgically place the testes in the scrotum) before puberty reduces the chance for testicular malignancy.

Question 7

Causes of infertility

Answer 7

Pretesticular, testicular, posttesticular

Question 8

Pretesticular causes of infertility

Answer 8

Extragonadal endocrine disorders (hypothalamic, pituitary, adrenal disorders).

Question 9

Testicular causes of infertility

Answer 9

Something intrinsically wrong with the testes

Question 10

Posttesticular causes of infertility

Answer 10

Duct obstrcution (congenital, inflammation, post surgical)

Question 11

Evaulation of infertility

Answer 11

History and physical examination must be done, semen analysis, detection of antisperm antibodies, sperm function tests, testicular biopsy (in the case of azoospermia).